Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 26NN09780100 | NJ |
NPI | 1154409332 |
---|---|
Provider Name | Ms. Diane Kenealy |
First Address | East Brunswick, NJ 08816-2017 |
Second Address | East Brunswick, NJ 08816-2017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |